Information for Referring GPs

Information for general practitioners referring patients to Dr Rhys Clark, orthopaedic surgeon. To make a referral or to discuss a patient, please phone (08) 6332 6365.

Subspecialty interests

• Hip — total hip replacement including the direct anterior approach, revision hip arthroplasty, and gluteal tendinopathy and GTPS
• Knee — robotic-assisted total and partial knee replacement, revision knee arthroplasty, arthroscopy, meniscal surgery and ACL reconstruction

The rooms are dedicated to hip and knee work. Dr Clark is part of the state sarcoma team at Sir Charles Gairdner Hospital, and one of his two fellowships at The Royal Orthopaedic Hospital in Birmingham was in sarcoma surgery, but suspected sarcoma and bone tumour referrals are best directed through the state sarcoma service rather than to these rooms.

How to send a referral

• Secure message — EDI drrclark
• Fax — (08) 6210 1816
• Phone — (08) 6332 6365, to refer or to discuss a patient

A referral is required for the patient to claim a Medicare rebate on the specialist consultation.

What to include in a referral

To help triage appropriately, referrals are most useful when they include:

• The working diagnosis and the affected side
• Relevant history and duration of symptoms
• Non-operative management already trialled — physiotherapy, analgesia, injections
• Current medications and relevant comorbidities
• Any imaging performed, with the accompanying reports

Knee arthritis referral criteria

Referral for knee arthritis is usually appropriate when symptoms are doing more than appearing on an X-ray. Useful triggers include:

• Pain limiting walking distance, work, sleep, travel or ordinary daily activity
• Symptoms persisting despite a genuine trial of non-operative care, including exercise-based physiotherapy and load management
• Progressive stiffness, loss of extension, varus or valgus deformity, or recurrent effusions
• Corticosteroid injections helping for a shorter period, or no longer helping
• A patient who has been told they need surgery and wants to understand whether partial or total knee replacement is appropriate
• A patient considering robotic-assisted total knee replacement in Perth and wanting a specialist arthroplasty opinion

Urgent referral or emergency assessment is more appropriate for suspected infection, fracture, tumour, acute haemarthrosis, acute locked knee, sudden inability to bear weight, or a hot swollen joint where septic arthritis is possible.

Imaging before referral

For suspected knee osteoarthritis, the most useful first-line imaging is usually weight-bearing X-ray:

• AP weight-bearing view
• Lateral view
• Skyline or Merchant patellofemoral view
• Long-leg alignment films if already available, particularly where deformity is marked

MRI is not routinely required before referral when weight-bearing X-rays already show established osteoarthritis. It can be useful when the clinical picture and X-rays do not match, where symptoms suggest another diagnosis, or where there is a traumatic injury pattern rather than gradual arthritis.

Private, public and self-funded pathways

Patients with private health insurance can usually be assessed in the rooms and, if surgery is recommended, booked through the private system. Dr Clark works on a no-gap basis for privately insured knee replacement patients; the patient should still receive informed financial consent covering the hospital, prosthesis, anaesthetist and assistant.

Patients without private insurance can still be assessed privately if they want a specialist opinion, but surgery through the public system follows the usual public referral and triage pathway. Self-funded knee replacement is possible for some patients; the knee replacement cost guide explains the public, private and self-funded routes.

Consulting locations

Murdoch — St John of God Medical Clinic, Suite 10, 100 Murdoch Drive, Murdoch WA 6150. Google Maps

Mandurah — SJOG Consulting Rooms, 117 Anstruther Road, Mandurah WA 6210. Google Maps

Surgery is performed at St John of God Murdoch, with public lists at Sir Charles Gairdner Hospital.

Fees

For privately insured knee replacement patients, Dr Clark works on a no-gap basis, matching his fees to the health fund payment. Further detail is on the cost of a knee replacement page.

For referrals or to discuss a patient, please phone (08) 6332 6365.